My main finding is that sex and gender each play a unique role in the determination of behavior and preferences on health care reform; however, neither dimension makes as much of a difference as party or ideology. The findings of this study are significant on two levels: first, that party and ideology continue to surpass secondary dimensions as primary motivators of a legislator's behavior; and second, that sex and gender appear to play out differently based on what aspect of legislating is examined. First, at the mass level, though it would appear that men and women possess different interests regarding health care, we see only a small gender gap in public opinion. At the elite level, an analysis of roll call votes shows significant differences between male and female legislators; however, an examination of the rhetoric used to explain these votes again shows little differences between male and female legislators. In addition,the distinction between sex and gender unfolds as we move from the mass to elite level and the idea of the presentation of self comes into play. At the rhetorical level, legislators appear to use gender in a manner consistent with Fenno's (1977) idea of the presentation of self: that is, they manipulate the social construct of gender in a strategic way to gain trust and support from their constituencies and therefore work toward the goal of reelection. This suggests that members of Congress, whether male or female, do not simply act on the basis of their sex, but that sex, gender, and party all come together in explaining legislators' behavior at various levels.